Wednesday, January 22, 2014
Editor’s Note: This is the third of a six-part series on the future of Emergency Medical Services.
EMS/911 responses are paid for by all.
Perhaps the bill is paid by Medicaid or Medicare. Or perhaps by insurance. Or perhaps not at all. However, the bill is paid for both the EMS and the ER visit, it ultimately costs each of us, be it through taxes or in higher costs of medical insurance.
Every time an ambulance staffed with highly trained EMS responds and transports a patient to a hospital, it costs approximately $483.89. This amount does not include the cost of vehicle maintenance, according to DCEMS Director Doug Warren.
“The easiest way to determine cost per transport is to take the annual operating budget and divide it by the number of transports,” he said.
“Thus, in FY 2013 the operating budget of the department was $4,778,945. In FY 2013 we responded to 15,308 calls, saw 13,411 patients and transported 9,876 patients.
“In Dorchester County, these services are billed.”
According to Warren, for 2012 the total billed (for EMS use) was $7,079,706.90.For 2012 the total paid was $3,619,012.33. Contractual and other write offs: $2,621,628.22 (required by law for Medicare and Medicaid etc.).
For 2012 the total unpaid was $839,066.45 from CY 2012, $1,385,333.36 including previous, he said.
Spartanburg operates under a joint county/hospital arrangement. The hospital manages the system and handles all billing. The county picks up the tab for unpaid transports.
For 2012, says Spartanburg EMS Director Jimmy Greene, EMS total expenses came to $11,072,910. The cost per call is $253.36.
Of that total cost, patients paid $9,443,006 and grants, insurance settlements and equipment sales covered $884,634 leaving the taxpayer (county) to pick up the remaining $745,270.
The National Association of State EMS Officials developed an EMS Cost Analysis Project. It created a framework that would allow users to determine the cost of providing pre-hospital emergency care from a societal prospective.
EMS falls under the auspices of The National Highway and Traffic Safety Administration. The NHTSA notes that “EMS systems are expensive to operate. The true economic burden of EMS is widely distributed and therefore well hidden from view. In the Medicare program alone, more than $2.5 billion is spent for patient transportation. It is estimated that $5 billion is spent on EMS in the United States each year.”
It defines an EMS system as all of the agencies that participate in acute, unscheduled healthcare outside the hospital within a defined geographic region.
Therefore, in order to accurately calculate the cost of the system, or for that matter each individual call, all agencies involved would need to be considered. For example, dispatch, police, fire, air lift, haz mat, ambulance and crew, maintenance for all of these as well as training costs, to name a few.
Then, in order to determine the efficacy of EMS, the outcome has to be agreed on. If it is mortality rate, then when is that determined? Is a “save” the arrival of the patient, alive, in the ER? The survival of that patient for three days? The survival of the patient for a month?
“One thing we know for sure,” according to the Journal for Emergency Medical Services, “is that the reimbursement many EMS agencies receive from Medicare, Medicaid, private insurance and from those who self-pay doesn’t come close to matching the costs of operating an EMS system.”